This proposal's primary purpose is to provide the candidate with the means and structure to achieve the following goals: l) Immediate Goals: determine the cost-effectiveness of incorporating alcohol screening and brief intervention into primary care and emergency department settings, and 2) Long-term Goals: develop into a leader in alcohol-related health services research and in primary care-based clinical preventive services for alcohol and substance abuse. The candidate will develop skills in health services utilization measurement, cost-effectiveness analysis, and health program evaluation via graduate-level course work, tutorials, workshops, institutional research seminars, interaction with mentors, and research. University of Pittsburgh resources integral to the candidate's development plan include the Center for Research on Health Care, the Graduate School of Public Health, the Center for Education and Drug Abuse Research, the Pittsburgh Alcohol Adolescent Research Center, and the Center for Injury Research and Control. The candidate proposes 2 studies. Study #1: Adds a cost and cost-effectiveness analysis to a NIAAA-funded clinical trial on brief interventions and stage of change in primary care settings. The main study will randomize 414 hazardous drinkers to one of two brief interventions, brief advice or motivational interviewing, or to standard care, and follows them for one year. This proposal will add utilization and cost measures to the baseline and follow-up assessments. The cost-effectiveness of the two brief interventions will be compared to standard care by relating the cost of the respective intervention to changes in alcohol use, health status, restricted activity days, and utilization. The incremental cost- effectiveness of motivational interviewing compared to brief advice and to standard care will be calculated for several study outcomes. Markov simulation modeling will be used to estimate incremental cost per quality-adjusted life-year gained for the interventions compared to each other and to standard care. 2) Study #2: This study will pilot an alcohol screening, assessment, and intervention program in an emergency department setting. The pilot study experience and data will be used to develop an R0l proposal to undertake a prospective study with the aim of determining the effectiveness and cost-effectiveness of such a program.